Mirasol M. Villaflores

 Clinical Nursing Competency Framework Appendix 1. Aseptic Technique Clinical Competency Name: Role: Clinic Assigned: Date of Clinical Skills Training : Date e assessment passed: Signature : Competency Statement: The participant demonstrates clinical knowledge and skill in the use of aseptic technique without assistance and/or direct supervision. Assessment in practice must be by a Practitioner who can demonstrate competence. Assessment Performance CriteriaNurse Signature Method Date Assessor The Participant will be able to: 1.Demonstrate practical knowledge in the use of aseptic technique a) Define the terms: Surgical Aseptic Technique Clean technique Aseptic technique Key part Key site Aseptic field Questioning b) Describe the general principles of AT Questioning c) Describe the principles of Clean Technique. Questioning d) Describe the factors which affect your choice of gloves for AT (ie sterile , non-sterile) Questioning e) Identify the appropriate technique for commonly performed procedures eg: . Indwelling urinary catheter insertion Intermittent catheterisation Administration of IV medication Phlebotomy Wound Care Aseptic Technique Clinical Competency Assessment Performance Criteria Method Nurse signature Date Assessor f) Describe how sterile equipment is best stored and how to tell if sterility of equipment has been breached. Questioning 2. Demonstrate practical skill to perform an AT procedure Direct Observation a) Inform guest about the procedure and seek verbal consent Direct observation b) Demonstrate appropriate selection of PPE for the task Direct observation c) Demonstrate appropriate selection and preparation of dressings/ devices for the task Direct observation d) Demonstrate preparation of the environment Direct observation e) Demonstrate correct hand hygiene technique (as per infection control Hand Hygiene. Direct observation f) Demonstrate ability to undertake non touch technique Direct observation g) Demonstrate ability to carry out clean technique Direct observation h) Demonstrate correct method for disposal of waste Direct observation i) Make clear, accurate and contemporaneous records of any actions and omissions. Direct observation Date all elements of Competency Tool completed ________ I confirm that I have attended initial training on _________and that I am confident and competent in aseptic technique. Practitioner____________ Signature _______________Status___________ Date ______ I confirm that I have assessed the above named Nurse and can verify that he/she demonstrates competency in aseptic and clean technique. Assessor ______________Signature _______________Status ___________ Date _______ Copy of assessment received by Line Manager Signature _______________Date_________ Appendix 2. Assessment of Guest/ Client Clinical Competencies Name: Role: Clinic Assigned: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill in assessment without assistance and/or direct supervision. Assessment in practice must be by a Registered Health Care Professional who can demonstrate competence. Assessor/self Performance CriteriaAssessment MethodNurse Signature Date assessed The Participant will be able to: 1.Demonstrate the knowledge and skill in assessing the guest / client a) Obtain details of the individual’s prior health status and circumstances to inform assessment, in accordance with the individual’s current situation observation b) Use appropriate questions to explore, clarify and confirm any unusual or ambiguous information observation c) Record the information clearly and accurately in a systematic and logical manner observation d) Treat all information provided to you as confidential in accordance with organisational policy and practice observation e) Respect the individual’s privacy, dignity, wishes and beliefs observation f) Check and confirm that the third party is able to provide you with relevant information and has the authority to provide you with information about the individual (when present) observation 2. Demonstrate ability to establish an individual’s functional capabilities a) Conduct the assessment systematically and thoroughly using appropriate methods and equipment to gather as full a picture as possible of the individual’s capabilities and any observation Assessor/self Performance CriteriaAssessment MethodNurse Signature Date assessed deficits b) Minimise any unnecessary discomfort and encourage the individual to participate as fully as possible in the process observation c) Monitor and record any changes in the individual’s health status and respond promptly to any signs of deterioration observation d) Use the information available at the time to develop a justifiable judgment with regard to: the functional capabilities of the individual the implications of any changes in the health status of the individual the nature, severity and extent of any deficits in the individual’s functional capabilities observation e) Recognise accurately potential signs of abuse and report them promptly to the appropriate person, in line with policy observation f) Form an accurate and justifiable evaluation of the risks to the individual making use of any protocols, guidelines or advice to inform your decision making observation g) Arrive at a judgment in an appropriate timeframe and refer the individual on to the appropriate pathway observation h) Seek additional support and advice from other practitioners as necessary to arrive at a satisfactory judgment observation i) Exchange information promptly with other practitioners involved in providing care programmes for the individual observation j) Discuss the outcome of your assessments with the individual, encouraging them to ask questions and confirm their understanding observation k) Maintain full, accurate and legible records of assessment observation Name ______________ Signature _______________Status___________ Date _______ I confirm that I have assessed the above named Registered Nurse and can verify that he/she demonstrates competency in guest / client assessment Assessor _____________________Signature _______________Status___________ Date _______ Review Dates: Competent Yes / No Health Care Professional / Assessor Signature Verifier signature Comments Appendix 3. Oxygen Therapy Clinical Competencies Name: Role: Clinic Assigned: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill in oxygen therapy administration without assistance and/or direct supervision. Assessment in practice must be by a Registered Nurse who can demonstrate competence. Performance Criteria Assessment Method Nurse signature Date Assessor/self assessed The Participant will be able to: 1.Demonstrate the knowledge and skill in meeting patient’s respiratory needs a) Has completed: baseline observations competencies Observation / questioning b) Demonstrate understanding of the safety considerations when using oxygen Observation / questioning c) Demonstrates understanding of equipment necessary to administer oxygen including; oxygen supply reduction gauge flowmeter tubing delivery mechanism ; mask or nasal cannulae humidifier Observation 2. Demonstrates ability to set up and administer oxygen therapy including: a) administration of oxygen via nasal cannuale Observation b) administration of oxygen via mask Observation c) Administration of oxygen via fixed performance or high flow mask Observation e) Administration of humidified oxygen Observation Date all elements of Competency Tool completed ________ Name _______________________ Signature _______________Status___________ Date _______ I confirm that I have assessed the above named Registered Nurse and can verify that he/she demonstrates competency in oxygen therapy administration Assessor _______________Signature _______________Status___________ Date _______ Review Dates: Competent Yes / No Registered Nurse Signature Verifier signature Comments Appendix 4. Communication Clinical Competencies Name: Role: Clinic Assigned: Date initial training / self-assessment completed: Competency Statement: The participant demonstrates clinical knowledge and skill in communicating with patient, families and other health care professionals without assistance and/or direct supervision. Assessment in practice must be by a Registered Nurse who can demonstrate competence. Assessor/self Performance CriteriaAssessment Method Dated Nurse sign assessed The Participant will be able to: 1.Demonstrate the ability to provide collaborative care in accordance with professional standards a) Discuss the principles that underpin the values set out in Registered Nurse practice Questioning b) work within limitations of the role and is self-aware and self-confident in recognising own level of competence Questioning / observation c) Demonstrates a professional image and acts as a role model in promoting a professional image Questioning / observation d) Show respect for others Questioning / observation e) Engage with others and build caring professional relationships Questioning / observation f) Initiate, maintain and closes appropriate and constructive professional relationships with families and other carers Questioning / observation g) Recognise and act to overcome barriers to effective relationships with patients and carers Questioning / observation 2. Provide person centred care and empower people to make choices a) Empower people to meet their own needs and make choices and considers with the person and their carer their capability to care Questioning / observation b) Provide personalised care, or makes provisions for those who are unable to maintain their own activities of living maintaining dignity at all times Questioning / observation c) Ensure access to independent advocacy Questioning / observation Assessor/self Performance CriteriaAssessment MethodNurse Signature Date assessed d) Recognise situations and acts appropriately when a person’s choice may compromise their safety or the safety of others Questioning / observation e) Use strategies to manage situations where a person’s wishes conflict with nursing interventions necessary for the person’s safety Questioning / observation f) Act with dignity and respect to ensure that people who are unable to meet their activities of living have choices about how these are met and feel empowered to do as much as possible for themselves Questioning / observation g) work autonomously, confidently and in partnership with people, families and carers to ensure that their needs are met through care planning and delivery. Including strategies for self care and peer support Questioning / observation h) Actively help people to identify and use their strengths to achieve their goals and aspirations Questioning / observation 3. Respect patients as individuals and preserve dignity at all times a) Act professionally to ensure that personal judgements, prejudices, values, attitudes and beliefs do not compromise care Questioning / observation b) Engage with people in a way that dignity is maintained Questioning / observation c) Use ways to maximise communication where hearing, vision or speech is compromised Questioning / observation d) Use appropriate and proactive approaches to empower and support patient choice Questioning / observation e) Act autonomously to challenge situations or others when someone’s dignity may be compromised Questioning / observation 4.Engage with patents and family in an acceptant and anti-discriminatory manner a) Demonstrate understanding of culture, religion, spiritual beliefs, gender and sexuality can impact on illness and disability Questioning b) Uphold people’s legal rights and speak out when these are at risk of being compromised Questioning c) Accepts differing cultural traditions and beliefs when planning care Questioning / observation d) Promote care environments that are culturally sensitive and free from discrimination, harassment and exploitation Questioning / observation Performance CriteriaAssessment Method Nurse Signature Date Assessor/self assessed d) Act appropriately in sharing information to enable and enhance care e.g. across agency boundaries Questioning / observation 8. Demonstrate ability to gain consent a) Demonstrate ability to gain informed consent Questioning / observation b) Work within legal frameworks when seeking consent Questioning / observation c) Assess and respond to needs of patient and family in relation to information and consent Questioning / observation d) Respect the autonomy and rights of people to withhold consent in relation to treatment within legal frameworks and in relation to patient safety Questioning / observation Date all elements of Competency Tool completed________ Review Dates: Competent Yes / No Registered Nurse Signature Verifier signature Comments Registered Nurse ______________ Signature _______________Status___________ Date _______ I confirm that I have assessed the above named individual and can verify that he/she demonstrates competency in in communicating with patient, families and other health care professionals Assessor_______________Signature _______________Status_____ Appendix 5: Phlebotomy Clinical Competencies Name: Role: Clinic Setting: Date initial training completed: Date aseptic technique e-assessment passed: Competency Statement: To become a competent practitioner, it is the responsibility of each person to undertake supervised practice in order to perform phlebotomy in a safe and skilled manner. Please document successful phlebotomy attempts. You must have achieved 5 successful attempts before completing the competency. Performance criteria Assessment method Level achieved Date Assessors signature Details; gender, age, vein used Comments e.g. number of insertions, reason Pass or fail 1. 2. 3. 4. 5. 1 Phlebotomy Clinical practice competencies Name: Role: Clinic Assigned: Date initial training completed: Competency Statement: The participant must perform this activity without assistance and/or direct supervision Performance criteria Assessment method Level achieved Date Assessor/ Self assessed The Participant will be able to: 1. The staff member must be able to demonstrate the following clinical skills a) Identify and select appropriate equipment including needle, collection system, winged needle collection sets, blood collection tubes for routine tests. Direct observation and questioning b) Correctly identify the patient by open questioning, and explain procedure to gain informed consent Direct observation C) Select suitable phlebotomy sites. Direct observation d) Pre-pare puncture site and identify if the patient requires skin to be cleansed, if so what to use Direct observation e) Correctly apply and use a disposable tourniquet Direct observation f) State optimum time for tourniquet application Direct observation g) Apply PPE and perform phlebotomy safely using an aseptic technique Direct observation h) Perform phlebotomy safely causing minimum distress to patient Using appropriate techniques to reduce distress and anxiety Direct observation i) State the correct filling order of sample tubes (Order of draw) Discussion and explanation k) Did the member of staff remove gloves decontaminate hands then label all samples correctly at the guest side Direct observation l) Dispose of sharps immediately after use in the correct sharps bin Direct observation m) Does the sample tube show the following information Full name Date of Birth Number Gender Date sample taken Are all details correct Signature if required 2. Health and safety - Can the member of staff identify: a) Safe practice when assembling and handling sharps Direct observation b) Carry out effective risk Direct observation 2 assessment using appropriate personal protective clothing e.g. gloves and apron c) Name three of the main blood borne viruses and their risks Questioning and answers d) State the infection control policy procedure when dealing with a sharps injury Questioning and answers e) Identify potential adverse incidents or near misses and report appropriately Questioning and answers 3. Infection Control - The staff member can- a) Demonstrate effective hand hygiene in accordance with infection control policy Direct observation b) Demonstrate an aseptic technique Direct observation c) Identify single use items Questioning and answers Date all elements of Competency Tool completed ___________ I confirm that I have attended initial training on ______________________________ and that I am confident and competent in phlebotomy procedure. Clinician: ________________________________ Signature________________________ Status: __________________________________Date: ____________________ I confirm that I have assessed the above named Clinician and can verify that he/she demonstrates competency in phlebotomy practice. Verifier____________________Signature_______________Status_________ Date________ Review Dates: Competent – Yes / No Clinician Signature Verifier signature Comments Appendix 6: Blood Glucose Monitoring Clinical Competency Name: Role: Clinic Assignment: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill in blood glucose monitoring without assistance and/or direct supervision. Assessment in practice must be by a Registered Health Care Professional who can demonstrate competence. Performance criteria Assessment method Nurse Signature Date Assessor/self assessed 1. The participant will be able to demonstrate the knowledge and skills to perform blood glucose monitoring. a) The reason for the patient needing blood glucose monitoring. Questioning b) The limitations of using a blood glucose meter. Questioning c) The rationale for calibrating meter, ensuring test strips are in date, performing internal Quality Control (QC) and external Quality Assurance (QA) Questioning d) Correct method to obtain blood sample. Questioning e) Significance of test results and how to interpret. Questioning f) When it is necessary to refer to a doctor or the diabetes nurse specialist. Questioning 2. The participant will be able to demonstrate practical skills in blood glucose monitoring. a) How to ensure accuracy of meter by demonstrating internal quality control (QC) check Observation b) Correct calibration procedure if needed for meter. Observation c) How to operate the meter. Observation d) Correct procedure for skin preparation. Observation e) Correct method to obtain blood sample. Observation f) Practices in accordance with clinic Infection Control Policy and Sharps Inoculation and Management Policy to avoid needle stick injury. Observation g) Practices in accordance with clinic Infection Prevention and Control Policy and Hand Hygiene Procedure and Standard Precautions Procedure to avoid contamination and cross infection. Observation h) Interprets and actions results in accordance with role and responsibilities. Observation i) Documents all care given in accordance with Trust policy & procedures. Observation Date all elements of competency tool completed ______________________ Name: _______________________________ Signature: __________________________ Status: ______________________________ Date: _______________________________ I confirm that I have assessed the above named individual and can verify that he/she demonstrates competency in blood glucose monitoring. Assessor: __________________________ Signature: ____________________________ Status: ____________________________ Date: _________________________________ Review dates Competent (yes/no) Healthcare Professional/ Assessor signature Verifier signature Comments Levels of competency rating scale Level of achievement Level Novice Cannot perform this activity satisfactorily to the level required in order to participate in the clinical environment 0 Can perform this activity but not without constant supervision and assistance 1 Can perform this activity with a basic understanding of theory and practice principles, but requires some supervision and assistance 2 Competent Practitioner Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision 3 Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision, at an appropriate pace and adhering to evidence based practice 4 Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision, at an appropriate pace and adhering to evidence based practice. At this level the practitioner will be able to adapt knowledge and skill to special/ novel situations where there maybe increased levels of complexity and/or risk 5 Expert Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision, at an appropriate pace and adhering to evidence based practice. 6 Can I describe the infection control precautions to take when undertaking blood glucose monitoring? Yes/No Yes/No Can I describe the appropriate equipment to use in undertaking the procedure for blood glucose monitoring? Yes/No Yes/No Can I describe the contradictions and test interferences to be aware of when blood glucose monitoring? Yes/No Yes/No 4 Blood Glucose Monitoring Clinical Competency Do I know: How to obtain verbal consent? Yes/No Yes/No How to prepare the patient for blood glucose monitoring? Yes/No Yes/No When and where to seek help if required? Yes/No Yes/No How to interpret and act upon blood glucose results appropriately Yes/No Yes/No How to care for the blood glucose meter and how and when to perform internal quality control (QC) and external quality assurance (QA) Yes/No Yes/No How to report an error or clinical incident and what to do if your meter fails QC or QA testing? Yes/No Yes/No STATEMENT OF COMPETENCE I certify that I am aware of my professional responsibility for continuing professional development and that I am accountable for my actions. With this in mind I make the following statement: I am competent to undertake Blood Glucose Monitoring without further training Signature: ……………………………………………………………… Date: ……………………… I require further training before I can undertake Blood Glucose Monitoring in a competent manner Signature: ……………………………………………………………… Date: ……………………… Keep this form in your personal portfolio or training record. Ensure your manager has seen the form when completed. Indicate how you plan to meet your learning needs: By when: Appendix 7. Falls prevention (Clinic based) Clinical Competencies Name: Role: Clinic Assignment: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill in falls prevention without assistance and/or direct supervision. Assessment in practice must be by a Registered Health Care Professional who can demonstrate competence. Assessor/self Performance CriteriaAssessment MethodNurse Signature Date assessed The Participant will be able to: 1. Demonstrate an in-depth understanding of the factors including lifestyle, which predispose or determine the risk of falls and the relative impact of these. a) Show awareness of current thinking/research in the falls arena Questioning b) Articulate the main intrinsic, extrinsic and behavioural risk factors for falling and demonstrate understanding of how these may interact by discussing specific patients encountered. Questioning c) Demonstrate an in-depth understanding of the medical conditions that may cause or increase the risk of falls and osteoporosis, and demonstrate understanding of how these may interact by discussing specific patients encountered. Questioning d) Interpret past medical history given in the context of patients’ falls history and draw conclusions about the likely cause of falls. Questioning e) Understand the role of polypharmacy and specific medications in causing falls and to take appropriate action in the presence of this risk factor. Questioning 2. Demonstrate a working knowledge of the clinical symptoms of osteoporosis a) Articulate the risk factors for Osteoporosis and demonstrate understanding of these factors, correctly identifying patients at risk. Questioning 3. Demonstrate a working knowledge of the possible physical and psychological effects of falls and osteoporosis on individuals and those who care for them Assessor/self Performance CriteriaAssessment Method Nurse Signature Date assessed a) Detect reduced confidence, self limitation of activity and fear of falling on subjective examination and know what referrals are needed if this is detected. Questioning 4. Demonstrate a working knowledge of the diagnostic, therapeutic and preventative interventions that are effective in assessing, managing and treating falls and osteoporosis and the effects of these on the overall health and well-being of individuals. a) Articulate simply what interventions work in managing falls and osteoporosis in community settings according to the evidence base. Questioning a) Demonstrate an in-depth understanding of the possible impact of the ageing process on individual’s communication needs Questioning, direct observation 7. Demonstrate an understanding of the procedures that must be followed if a patient falls while on the clinic setting a) Demonstrate immediate assessment and care of the patient Questioning, direct observation b) Demonstrate knowledge of deterioration in patients condition and when medical intervention is required Questioning, direct observation Performance CriteriaAssessment MethodNurse Signature Date Assessor/self assessed c) Demonstrate knowledge of the procedure to follow in the case of a fall with suspected head injury or an unwitnessed fall Questioning, direct observation d) Demonstrate understanding of information required in order to report a fall using safety reporting system. Questioning, direct observation 8. Fulfil the role of falls champion for the team, acting as a source of expertise for falls Date all elements of Competency Tool completed ________ Name _______________________ Signature ______________Status___________ Date _______ I confirm that I have assessed the above named individual and can verify that he/she demonstrates competency in falls prevention Assessor ______________________Signature _______________ Review Dates: Competent Yes / No Health Care Professional / Assessor Signature Verifier signature Comments Appendix 8. Wound Management Clinical Competencies Name: Role: Clinic assigned: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill in the management of wounds without assistance and/or direct supervision. Assessment in practice must be by a Registered Nurse who can demonstrate competence. Assessor/self Performance CriteriaAssessment MethodNurse Signature Date assessed The Participant will be able to: 1.Demonstrate the ability to take a wound swab a) Discuss the guidelines for bacterial sampling / wound swabs Questioning b) Describe the indications for use of a wound swab Questioning c) Describe the contraindications for performing a wound swab Questioning d) Demonstrate and record patient / guest informed consent Observation e) Demonstrate the ability to perform a wound swab Observation f) Demonstrate the ability to follow infection control guidelines during all stages of the procedure Observation 2. Demonstrate the ability to remove would closure devices a) Demonstrate the ability to remove sutures Observation/ Questioning b) Demonstrate the ability to remove clips Observation c) Demonstrate the ability to follow infection control guidelines in all procedures Observation e) Describe the contraindications / precautions when removing a wound closure device Questioning / observation 3. Demonstrate the ability to apply secondary would dressings bandages Performance Criteria Assessor/self Assessment MethodNurse Signature Date assessed a) Demonstrate the ability to apply a stump bandage dressing Questioning / observation b) Demonstrate the ability to apply a finger bandage dressing Questioning / observation c) Demonstrate the ability to apply a tubular bandages Questioning / observation 4.Demonstrate the ability to use wound management medical devices a) Demonstrate the ability to apply and remove a wound drainage bag Observation b) Discuss the guidelines/ instructions for use of a wound drainage bag questioning c) Describe the indications for use of a wound drainage product questioning d) Describe the contraindications / precautions for use of a wound drainage bag questioning e) Discuss the explanation that will be given to a patient for the use of the product questioning f) Discuss when to stop the use of the product questioning Date all elements of Competency Tool completed ________ Name __________________________ Signature _______________ Status___________ Date _______ I confirm that I have assessed the above named individual and can verify that he/she demonstrates competency in wound management Review Dates: Competent Yes / No Registered Nurse Signature Verifier signature Comments Assessor _______________Signature _______________Status_________ Appendix 9. Electrocardiogram Clinical Competency Name: Role: Clinic Assigned: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill to perform and electrocardiogram without assistance and/or direct supervision. Assessment in practice must be by a Registered Health care Professional who can demonstrate competence at level 4 or above. Assessor/self Performance CriteriaAssessment Method Date Nurse Signature assessed The Participant will be able to: 1.Demonstrate the principles and practice of performing an electrocardiogram (ECG) a) Define an ECG questioning b) State 3 clinical reasons for recording and ECG questioning c) Demonstrate the appropriate safety checks that must be made before using the ECG machine questioning d) Explain the factors that need to be addressed to secure consent before the ECG is performed questioning e) Describe the patient safety checks to be made prior to recording an ECG questioning f) Describe 3 situations when an ECG may prove to be difficult to record questioning g) Demonstrate the correct position of the patient when recording an ECG questioning h) Demonstrate appropriate skin preparation prior to recording an ECG questioning i) Demonstrate the correct lead positions questioning j) Trouble shooting questions. 1) What action would you take to minimise interference on the ECG? 2)What would you do if only 1 lead on the ECG recording showed a straight line? 3)What would you do if all leads come up as straight lines on the ECG despite being in the correct position? questioning Assessor/self Performance CriteriaAssessment MethodLevel achievedDate assessed 2. Demonstrate the recording of an ECG in practice a) Ensure that all equipment is safe and in full working order Observation b) Use equipment in the correct manner in line with local policy Observation c) Access the correct records / clinic list of patients Observation d) Greet the patient/ guest and confirm identity Observation e) Explain the procedure and demonstrate a manner which respects his / her beliefs, and which ensures privacy, dignity and confidentiality is preserved at all times Observation f) Obtain consent from the patient. Describe what action you would take if consent could not be obtained Observation g) Identify any special needs which may affect performance of the test or influence results Observation h) Obtain information from the patient regarding symptoms or signs of pathology which may occur during the procedure Observation i) Give clear instructions to the patient during the procedure in a sensitive and reassuring manner. Encourage the patient to relax and remain immobile during the procedure Observation j) Accurately identify the electrode sites and correctly position the electrodes, taking into account any identified special needs. Observation k) Test and run monitoring device and check quality of output Observation l) React promptly and appropriately to any adverse clinical changes in the patient’s status. Observation m) Confirm completion of procedure with patient and remove electrodes / ECG tabs Observation n) Correctly label documents and recording devices with patient details, clinical details, date of procedure and the person performing the procedure Observation Performance Criteria Assessment Method Level achieved Date Assessor/self assessed o) Inform patient of next action Observation p) Ensure the ECG is reviewed by an identified person competent in ECG interpretation. Observation Date all elements of Competency Tool completed ______ Name __________________ Signature ___________________Status______________ Date_______ I confirm that I have assessed the above named individual and can verify that he/she demonstrates competency in performing an electrocardiogram Review Dates: Competent Yes / No Health Care Professional / Assessor Signature Verifier signature Comments Assessor_____________________ Signature _____________________Status______________